Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SUNDAY, April 17, 1994                   TAG: 9404170069
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-1   EDITION: METRO 
SOURCE: Associated Press
DATELINE:                                 LENGTH: Long

IS RISK OF AIDS OVERSOLD?

Over and over, public service ads picture mostly folks who are heterosexual, who look comfortably well off and who, more often than not, are white.

The message is reinforced by such campaigns as the "America Responds to AIDS" ads of the U.S. Centers for Disease Control and Prevention, and it is simple: AIDS is a threat to the middle class.

But is it? Should people like these lose sleep over getting AIDS?

Opinions differ, but a backlash seems to be emerging against what some say is an overzealous job of selling this epidemic to most people.

In fact, there is no sign that AIDS has spread to any extent into the mainstream of American life, and many believe it probably never will.

As for the typical American - someone who is straight, who is not very promiscuous, who does not shoot drugs or knowingly sleep with those who do - most experts agree the risk of AIDS falls somewhere been low and infinitesimal.

Yet the public health message often implies otherwise. This democratization of AIDS, the quest to make it Middle America's health worry, troubles some.

"It's a very well-meaning attempt by people who care about this problem. But this kind of approach will ultimately backfire, because people will eventually realize that not everyone carries the same degree of risk," said Jeff Stryker, a researcher at the Center for AIDS Prevention Studies at the University of California, San Francisco.

In the view of some, the risk of AIDS is deliberately distorted for political reasons.

"As a physician who takes care of people with HIV, I get fairly irritated when I see public health messages that try to depict white, middle-class people," said Dr. Deborah Cotton of Massachusetts General Hospital.

"It doesn't make any sense at all," Cotton said. "I fear the reason is, we live in a racist society where the health problems of whites are considered to be more important. So we have to package this disease as a threat to the white middle class to get funding for it, to get attention, to get support."

On the other hand, those who support broad-based AIDS warnings argue that no man or woman is 100 percent safe unless he or she avoids sex entirely or has just one partner, known to be HIV-free.

AIDS clearly does spread heterosexually. A bisexual man can catch HIV from another man and pass it to a woman, who in turn infects other men. A prostitute might pick up the virus from her drug-addicted boyfriend and give it to her customers, who then take it home to their wives.

"These sorts of risks may be episodic, they may be intermittent, but they are real and compelling and hard to predict," said Dr. Sten Vermund, chief of epidemiology at the National Institute of Allergy and Infectious Diseases.

In fact, some are uncomfortable with the idea of telling people their risk is slight. They fear it will prompt them to abandon caution. And since the risk is not zero, it still makes sense to use condoms and choose sex partners carefully.

The message of middle-class risk was developed early in the epidemic, when public health officials feared the disease would break free of the two groups it almost exclusively afflicted - homosexual men and intravenous drug abusers.

AIDS is still largely confined to these two categories. Of the cases reported last year, 47 percent got the disease through homosexual intercourse, and 28 percent from sharing needles. The proportion attributed to heterosexual contact has risen gradually since the mid-1980s. In 1993, it edged up 0.8 of a percentage point to 9 percent of the year's new cases.

No large random survey has ever been done to see how many heterosexuals carry the virus and risk infecting others. However, several glimpses into the population suggest HIV has not made broad inroads. Among these:

There is no sign that the total number of infected people in the United States is increasing rapidly, as would happen if there was substantial heterosexual spread.

Most women who give birth are anonymously tested for HIV. In 1990, 16 of every 10,000 in the United States were infected. Two years later, this was virtually unchanged at 17 in 10,000.

The AIDS infection rate among first-time blood donors is falling. In 1985, it was seven in 10,000. Now it is down to four in 10,000. Among women, just two in 10,000 donors have HIV.

Among military recruits, the infection rate in men has fallen threefold since 1985 but held steady in women.

"We have two epidemics: one among gay men; and one in the inner city among intravenous drug users, their sex partners and their children," said John Gagnon, a sociologist at the State University of New York at Stony Brook.

Dr. John Ward, the CDC's chief of AIDS surveillance, agrees that the risk of AIDS to most heterosexual Americans is low. But he said the goal of the public health message has always been to prevent the spread of a lethal disease.

"We have not tried to make the risk look overwhelming to people or said that everyone in America will get AIDS," he said. "We have tried to be responsible in saying that heterosexual transmission is a risk."